Endometriosis is a disorder in which tissue similar to that of your uterus lining (endometrium) grows outside of your uterine cavity. This endometrial-like tissue can grow on the bowel, ovaries, and tissue lining the pelvis, and behaves like an endometrial tissue would – it grows, thickens and breaks down during each menstrual cycle. However, since there’s no way for the tissue to exit the body, it becomes trapped within the pelvic region. Endometriosis involving the ovaries may also result in the formation of cysts, or endometriomas. Surrounding tissue can become inflamed and irritated, causing scar tissue and adhesions to develop. As a result, endometriosis is often characterised by pelvic pain.
It is estimated that about 10% of women and girls worldwide suffer from endometriosis.
What are the symptoms of endometriosis?
Apart from pelvic pain, there are other symptoms associated with endometriosis:
- Severe pain during menstrual periods
- Cramps that begin one or two weeks before menstruation
- Heavy menstrual bleeding or bleeding between periods
- Pain with intercourse, urination and bowel movements
- Bloating or nausea
It’s worth noting that the symptoms of endometriosis may vary, and the severity of your pain may not be an accurate indicator of the extent of your condition. For example, you may experience excruciating pain with a mild condition. Similarly, it’s possible to have a severe condition with little or no symptoms.
Endometriosis can be mistaken for other disorders that cause pelvic pain, including irritable bowel syndrome (IBS), pelvic inflammatory disease (PID) and ovarian cysts. Hence, it is important to see a doctor for a diagnosis as soon as symptoms begin. An early diagnosis can help with managing and treating your condition.
What are the causes of endometriosis?
While the exact cause of endometriosis is unknown, there are several possible explanations for this condition:
- Retrograde menstruation: This occurs when menstrual blood flows back to the pelvic cavity through the fallopian tubes instead of leaving the body through the vagina.
- Hormones: Hormones may promote the transformation of cells outside of the uterus into endometrial cells.
- Immune system: A malfunctioning immune system may fail to identify and destroy endometrial-like tissue growing outside of the uterus.
- Surgery: During an abdominal surgery, such as a cesarean delivery (C-section) or hysterectomy, endometrial tissue could be displaced.
- Developmental abnormalities in the female reproductive system: The Müllerian theory suggests that endometriosis begins in the fetal period, where cell tissue is displaced due to developmental abnormalities in the reproductive system.
There are also certain factors that increase the risk of developing endometriosis, such as:
- Getting your first period at an early age
- Having a family history of endometriosis
- Having short menstrual cycles of less than 27 days
- Having heavy menstrual periods that last more than 7 days
- Never giving birth
- Reproductive tract disorders
- Being underweight
What are the treatment options for endometriosis?
There’s no cure for endometriosis, but there are treatment options available to manage your symptoms, including:
- Pain medication
- Hormone therapy
- Hormonal contraceptives
- Medication for menstrual suppression
- Conservative surgery, like laparoscopy, to remove displaced endometrial tissue
- Last-resort surgery, like having a hysterectomy, to remove the uterus and cervix
Your doctor will recommend treatment options for you according to your diagnosis and existing health condition. To aid diagnosis, your doctor may perform a series of examinations, including:
- A pelvic examination to check your abdomen for cysts and scars behind the uterus
- An ultrasound to identify cysts associated with endometriosis
- A laparoscopy to identify endometriosis
When to see a doctor for endometriosis
Apart from improving treatment outcomes, getting an early diagnosis for endometriosis is also important to lower your risk of complications, such as infertility and ovarian cancer. If you suspect that you have endometriosis, please speak to our doctors at Osler Health.